Stabilisation of sagittal split advancement osteotomies with miniplates: a prospective, multicentre study with two-year follow-up

Abstract

Hof:Stabilisation of sagittal split advancement osteotomies with miniplates: a prospective, multicentre study with two-year follow-up Part I. Clinical parameters. Int.Abstract. The principal aim of this study was to assess the postoperative stability of bilateral sagittal split osteotomies (BSSO) using two miniplates. Part I reports on the clinical results including treatment characteristics, nerve functions, TMJ function, occlusional relapse and patient satisfaction.This prospective study evaluated a group of 222 patients who underwent a BSSO for mandibular advancement. The same treatment protocol was used at seven participating institutions at which the patients were treated. A stable occlusion without appreciable relapse was seen in 84% after 2 years of followup. A considerable minority (16%) had occlusal relapse. There were no clinical parameters that pointed towards a high risk for relapse except age. The mean operation age of the relapse group was 20.7 years (SD 6.7) and in the stable group 26.1 years (SD 8.2).The function of the inferior alveolar nerve 2 years postoperatively was reported to be normal in approximately 88% of the patients, while 94% had no complaints about nerve dysaesthesia.In approximately 56% of the patients with pre-existing TMJ-dysfunction these signs and symptoms had disappeared. Another group of patients, however, without TMJ-dysfunction preoperatively (22%) developed signs or symptoms of TMJ-dysfunction postoperatively.The sagittal split osteotomy fixed with miniplates appeared to be a relatively safe and reliable procedure giving rise to a high degree of patient satisfaction, despite the fact that some occlusal relapse was seen.

TMJ response to mandibular advancement surgery: an overview of risk factors

“…In the short term, an increase in muscle and TMJ symptoms was normally found after mandibular advancement surgery, and this tended to decline over time, without being considered a risk factor for TMD 54 . On the other hand, it cannot be overlooked that there is also a risk of asymptomatic patients developing TMD after surgery 20,79,115,120,124,142 , and the condition of patients with TMJ symptoms worsening after surgery 12,103,108,142 .…”

“…Studies have concluded that SSRO of the mandible has a favorable effect on TMJ symptoms 20,31,55,120,141,142 , with better evolution for mandibular prognathism than mandibular retrognathism 141,142 . More specifically, De Clercq, et al 31 (1995) found significantly fewer post-operative TMJ symptoms in normal/low angle mandibular deficiency deformity, while there was no significant difference in the high angle group.…”

“…The adverse effects of mandibular advancement surgery on the TMJs form a pertinent theme well explored in the literature 5,7,20,29,56,65,81,99,104,105,134,138,139,142 . The TMJ response ranged from adaptive, which included physiological bone remodeling 28,34,45 , to irreversible complications 9,10,55 .…”

Risk factors contributing to symptomatic miniplate removal: a retrospective study of 153 bilateral sagittal split osteotomy patients

“…BORSTLAP et al 6 reported a high plate removal rate of 55%, but only 7% of these were removed due to infection related reasons, and the authors therefore assume that the Removal of miniplates in BSSO patients 433 reason for the high removal frequency was an active policy of routine plate removal. In other studies, plate removal rates range from 7% to 16% 2,10,17 .…”

“…Removals that were caused by platerelated complications were performed significantly sooner (a mean of 306 days postoperatively) than removals due to subjective discomfort (a mean of 608 days postoperatively). THEODOSSY et al 17 reported that plate removal was performed at a mean of 5.5 months (range 2-12 months) postoperatively, whereas BORS-TLAP et al 6 observed that all plates that needed removal were removed within 8 months postoperatively. In the present study, three patients had a follow-up time of less than 100 days and seven patients had a follow-up time of more than 100 days but less than 200 days.…”